I am taking this Adjournment matter on behalf of my colleague, the Minister for Health and Children, Deputy Harney.
The long-term illness scheme arose from a non-statutory scheme, established in 1967, to supply free of charge certain products to persons for the treatment of diabetes. A statutory scheme was introduced in 1971 under section 59(3) of the Health Act 1970. It provides that a health board — now the HSE — may make arrangements for the supply without charge of drugs, medicines or medical and surgical appliances to persons suffering from a prescribed disease or disability of a permanent or long-term nature. The conditions which have been prescribed are: mental handicap, mental illness, for people under 16 years only, phenylketonuria, cystic fibrosis, spina bifida, hydrocephalus, diabetes mellitus, diabetes insipidus, haemophilia, cerebral palsy, epilepsy, multiple sclerosis, muscular dystrophies, Parkinsonism, conditions arising from thalidomide and acute leukaemia.
From 1971, a separate scheme was introduced to refund the cost of drugs above a certain threshold for non-medical card holders. This evolved into the drugs payment scheme in 1999. Under this scheme, no individual or family unit pays more than €100 per calendar month towards the cost of approved prescribed medicines. The scheme is easy to use and significantly reduces the cost burden for families and individuals incurring ongoing expenditure on medicines.
When the drugs payment scheme was introduced, it was decided to continue the long-term illness scheme for the conditions already covered. The list has not been extended and there are no plans to do so. People who cannot, without undue hardship, arrange for the provision of medical services for themselves and their dependants may be entitled to a medical card. In the assessment process the Health Service Executive can take into account medical costs incurred by an individual or a family. Those who are not eligible for a medical card may still be able to avail of a GP visit card which covers the cost of general practice consultations.
Fibromyalgia, sometimes called fibrositis, is a common condition associated with widespread aching, stiffness and fatigue and originates in muscles and soft tissues. Many patients have no underlying disorders, while others who develop fibromyalgia may have conditions such as rheumatoid or spinal arthritis. As the condition known as fibromyalgia is not a notifiable disease, its incidence is not monitored by the Department. Its cause is unknown, but there may be a link with immune or endocrine abnormalities or biochemical abnormalities in the central nervous system such as altered serotonin levels.
In 2008 the Department published its chronic disease policy which set out how chronic conditions, including musculoskeletal disorders, should be managed and how patients could be supported with self-care in managing their condition. In 2006 the Health Service Executive published the work of a national working group on arthritis and related conditions which is reviewing how services are provided and it is intended to make recommendations on the development of services in response to a comprehensive needs assessment. This ten-year development plan is near completion and will deal with current services, including how best to integrate primary and secondary care services for patients with arthritis and related conditions. A key element of this plan is the concept of supporting "self-management" which aims to develop the personal skills and self-management capabilities of the population who have arthritis or related conditions. This involves improving awareness of arthritis and related conditions and using self-management support strategies, including pain management and how best to live and work with these conditions.
The Department of Social and Family Affairs has advised that it recognises fibromyalgia as a medical condition as classified by the World Health Organization international classification of diseases. That Department is working with ATOS Healthcare to develop protocols for its assessment by its medical assessors. Fibromyalgia will be included in the protocols being developed at this time and which it is intended will be fully operational by the end of July 2010. The Department has also taken steps to increase awareness of the condition among its medical assessors. A presentation on fibromyalgia by a specialist in rheumatology was delivered recently to the medical assessor cadre.
